When to Go to the Emergency Department and What to Expect

When to Go to the Emergency Department and what to Expect.

Reasons to Go:

    • Wheezing, shortness of breath, or difficulty breathing
    • Chest pain
    • Fractures
    • Fainting or dizziness
    • Sudden numbness or weakness
    • Bleeding that can’t be stopped
    • Abdominal pain- especially intense localized (in one spot)
    • Fever with convulsions or any fever in children under 3 months
    • Confusion or changes in mental status
    • Coughing or vomiting blood
    • Severe headache or head injury, especially on aspirin or blood thinners
    • Blood in the urine, or bloody diarrhea
    • Sudden inability to speak, see, walk, or move

COVID Screening:

    • You will be asked if you have a fever, cough, or had contact with COVID-19
    • You will have your temperature checked
    • A facemask will be provided if you don’t have one
    • You may be asked to go back to your private vehicle or waiting room until a bed is ready

 

Emergency Department Routine:

           Triage: A nurse will evaluate the seriousness of your illness or injury

    • They will check your temperature, blood pressure, heart rate and ask questions.
    • You may be sent back to your private vehicle or to the waiting room until a bed is ready.
    • Tell a nurse if you have difficulty with overstimulating environments or long waits.
    • Ask if they have a quieter area for minor illnesses/injuries to help you to be seen ASAP.
    • Inform the nurse of any special communication needs.

          Registration: How a medical record is made of your visit. 

    • Have a photo identification card and your medical insurance card with you.
    • You will be asked to sign a consent form for treatment and payment responsibility.

          Examination: Staff will prepare you to be seen by the doctor. 

    • Blood tests, x-rays, or other tests may be taken at this time.
    • The nurse and doctor will do the best they can to relieve your pain as soon as possible.
    • Sometimes medication can only be given after tests or x-rays have been completed.
    • X-rays are looked at first by an emergency doctor and also read by a radiologist.

          Long Wait Times: There are many reasons I may have to wait. 

    • Critically ill or injured patients need immediate treatment, even if they arrived after you.
    • Lab and/or x-ray has been called to perform a procedure to help evaluate your condition. Lab tests are highly complicated and take time to complete.
    • A specialty room is needed for your treatment.

          Family and Caregivers: What if I need help?

    • If you need your family or caregiver to  help you communicate, you tell the nurse during triage and registration.

           Discharge: When care is complete

    • Staff will provide you with written and verbal instructions.
    • If it’s necessary for you to be admitted to the hospital, your ED physician will coordinate with your doctor or one of the hospital’s in-house doctors.

           Billing: You may need to pay your co-pay before you leave

    • You should have money or a debit or credit card with you to make this payment.

What to Expect When You Call 9-1-1

Who will Answer Your Call?

    • Your phone call will be answered by a trained professional. They will ask you very specific questions.
    • Your answers to these questions will help determine which emergency service they should send (firefighters, police, ambulance, etc.)
    • There is important information that you will need to know to answer these questions.

 

 What Kind of Questions Will They Ask?

    • What is the address of the emergency?
    • What is your callback number (your phone number)?
    • There are 4 questions all 9-1-1 emergency personnel need to know.
      • What is the emergency?
      • What is the person’s approximate age? Is he or she conscious (awake)?
      • Is he or she breathing?

 

Important Things You Need to Do

    • Be calm and listen carefully!
    • If you’re able, do exactly what the emergency person asks you to do.
    • Don’t tell them to “hurry”. They’re aware of the situation and are getting help as they’re talking to you.
    • They may ask you to do nothing until help arrives.
    • They may tell you get out of an unsafe environment
    • They may ask you to stay on the phone and assist in providing care for the ill or injured person.

Educate Your Local Emergency Department About Being on the Spectrum

Advocating for Yourself or Your Family Member With Autism

    • If possible, provide your local hospital with
      information about your autism before an emergency arises.
    • Provide information on:
      • The best way to communicate.
      • Sensory issues.
      • How well you tolerate long waits.
      • If you need a quiet environment.
      • Ways to help you remain calm.
      • Any fears or anxieties.
      • If you want someone (a family member or caregiver) to remain with you.

 

Share Information in Advance of Going to the Emergency Department

    • Ask your primary care or specialist doctor to share your electronic records.
    • Complete the questionnaire (provided below) and give it to the hospital in advance of a potential
      visit to the emergency department.
    • These ways present opportunities to empower individuals with autism, their loved ones, and/or
      caregivers to:

      • Optimize care in the emergency department.
      • Educate health care providers on the nuances of their condition.
      • Set expectations for the type of treatment to be provided.

Common Reasons Someone With Autism Seeks Emergency Care

Be Aware of Common Outpatient Therapies for Patients with ASD

    • Risperidone – Most evidence-based therapy, used for irritability and disruptive behaviors.
    • Methylphenidate – Used for hyperactivity, side effects of decreased appetite, and abdominal discomfort.
    • SSRIs – More evidence for benefit in adults (obsessive-compulsive symptoms, aggression, and anxiety), side effects of agitation, suicidal ideation early in treatment.
    • Specialized Diets and Chelation Therapies – No clear evidence for benefit, side effects of nutritional deficiencies, hypocalcemia, Stevens-Johnson Syndrome.

Common Complaints of ASD Patients in the ED

Individuals on the spectrum may present with conditions specific to ASD and more common conditions seen in th general population, but with atypical symptoms.

Gastro-Intestinal Disorders

Presentation

    • Poor oral intake.
    • Stereotyped eating habits and subsequent dietary imbalances.
    • Increased prevalence of constipation and/or diarrhea.
    • Pica is common.

Considerations

    • Assess for weight loss, decreased
      growth, GI bleeding, fever, right-sided abdominal pain, vomiting, and diarrhea.
    • If absent, consider functional cause- obtain an abdominal x-ray and consider antacid and/or pro-motility agents (Polyethylene Glycol).

Catatonia

Presentation

      • Increase immobility.
      • Slow in movements and refusing to speak.
      • Unusual posturing.

Considerations

    • “Shut Down” syndrome.
    • The differential is quite broad – endocrine, neurologic, metabolic, medication related.
    • The initial diagnostic evaluation is accomplished through the lorazepam challenge test.

Ophthalmologic Conditions

Presentation

    • Behavioral agitation.
    • Significant tearing of the eye.

Considerations

    • Discuss with the caregiver how the patient expresses pain or discomfort.
    • Discuss with the caregiver dietary habits -check for vision loss due to Vitamin A deficiencies.
    • Check for metallic foreign bodies (an increased possibility with ASD) .

Infectious Disease

Presentation

    • Fever.
    • Rash.
    • Pain, shortness of breath.

Considerations

    • Consider disease, such as measles in the differential for ASD patients.
    • In a non-judgmental way, obtain a vaccination history in some detail on ED patients with AS .

Psychiatric and Neurological Presentations

    • Presentations Anxiety/depression.
    • Substance abuse.
    • Seizures.

Injurious Behavior

Presentation

    • Presents with fracture-skull, forearm, or facial.
    • Individuals with ASD have a lower incidence of fractures, in general.
    • Individuals with ASD have an increased incidence of self-injurious
      behavior.

Considerations

    • Take careful history to determine if due to abuse or not.
    • Understanding these injury patterns can aid in resolving what can be a difficult disposition situation.

Dental

Presentation

    • Increased agitation or decreased oral intake.

Consideration

    • Dental pain should be considered i
      those with agitation or decreased oral intake.
    • Bruxism, anticonvulsant medications, restricted diets, and sensory aversion to oral care may lead to gingivitis.
    • A good oral exam should be routine in patients with ASD.

Understanding Autism Spectrum Disorder (ASD): a Guide for Emergency Medical Personnel

Developmental Disability

    • Can be on a spectrum from barely noticeable to profoundly disabling.
    • Can have significant social, communication, and behavioral challenges.
    • Can have intelligence that ranges from intellectual disability to gifted.
    • Frequently have comorbid conditions (genetic, behavioral, or medical/mental health).

Autism Spectrum Disorder (ASD)

    • In the DSM-V, Autistic Disorder, PDD-NOS, and Asperger Syndrome were combined into a broader category called autism spectrum disorder. This spectrum is further distinguished by the levels of severity.
    • The core features of ASD are persistent deficits in social communication and social interaction and restricted, repetitive patterns of behavior, interests, or activities.
    • These core symptoms can present as: repetitive routines or rituals, peculiarities in speech and language, socially and emotionally inappropriate behavior, inability to interact successfully with peers, problems with non-verbal communication, and clumsy and uncoordinated motor movements.

 

Signs and Symptoms that ASD May Be Evident

"Social/Communication"

    • Delayed speech and language skills.
    • Talks in a flat, robot-like, or sing-song voice.
    • Uses reverse pronouns (“you” instead of “I”).
    • Repeats or echos words/phrases or repeat words/phrases in place of normal language.
    • Trouble expressing their needs using typical words or motions.
    • Does not use or has difficulty understanding gestures/ body language.
    • Unusually talkative (verbose) with little conversational turn-taking.
    • Appears unaware when people talk to them but respond to other sounds.
    • Avoids eye contact and prefers to be alone.
    • Difficulty relating to others or little or no interest in other people.
    • Trouble understanding other people’s feelings or talking about their own feelings.
    • Does not understand jokes, sarcasm, or teasing.
    • Interested in people, but does not know how to talk, play, or relate to them.
    • Deficits in attention (doesn’t point at objects to show interest or look at objects when another person points at them .

"Sensory"

    • Seeks (rather than resists) particular sensory input (ex: weighted blanket).
    • Avoids or resists physical contact. Unusual reactions to the way things smell, taste, look, feel, or sound.
    • Does not understand personal space boundaries.

"Adaptive Behavior"

  • Engage in Stimming (self-stimulation) behavior; repeating actions over and over again (ie, rocking, swaying, jumping, finger flicking).
  • Trouble adapting when a routine changes.
  • Meltdowns; increase when stressed, fatigued, or feeling unwell.

ACT for Autism: For EMS and First Responders

ACT (Assessment and Communication Tactics) provides a framework for response from EMS and other first responders. ACT takes a two-pronged approach.

"Assessment":

Assess and Control the Situation

  1. Gain as much information as possible about what led to or surrounds a situation.
  2. Determine the best way to approach or communicate with the individual.
  3. Minimize sensory stimuli, such as flashing lights, sirens, high-volume walkie talkie devices, loud yelling among responders, and eliminate non-essential persons.

"Communication":

Communicate to Gain Understanding and Compliance or to De-escalate the Situation

  1. Approach slowly and calmly keeping, some distance between you.
  2. Use the person’s first name (if you know it) and assure you are there to help.
  3. Talk in a quiet and calm voice and try to establish a rapport, no matter how urgent the situation.
  4. Give simple, clear directions paired with a visual or demonstration.
  5. Don’t attempt to touch, grab, or restrain the individual without preparing him/her, first. Explain what you’re going to do or want him/her to do.
  6. Ask yes/no questions and avoid sentences or questions that require more complex responses.
  7. Allow the person time to calm down.

ACT for Autism: For Emergency Department Staff

Treat) provides a framework for response from healthcare providers. ACT takes a triangulated approach.

"Assess" the environment and best approach or communication mode to gain information.

  1. Prepare a quiet exam room.
  2. Minimize sensory stimuli (clutter, loud equipment, bright lights).
  3. Eliminate non- essential staff. 4. Determine the best way to approach or communicate.
  4. Gain as much info as possible from both the patient and the caregiver.

"Communicate" to gain history, examine, and evaluate.

  1. Approach slowly and calmly, keeping some distance.
  2. Use their first name and assure you’re there to help.
  3. Talk in a quiet/calm voice.
  4. Try to establish a rapport, no matter how urgent.
  5. Don’t attempt to touch, grab, or restrain without preparing the individual, first.
  6. Before examining, explain what you are going to do or want him/her to do.
  7. Ask simple yes/no questions.
  8. Avoid questions that require complex responses.
  9. Allow the person time to calm down and added time to process and respond.

"Treat" using care and consideration.

  1. Consider sensory issues (taste/smell of medication, textures or temperature of materials).
  2. Show materials beforehand and let the patient touch them (if possible).
  3. Model intervention on the caregiver.
  4. Cover splint or bandages with non- threatening images for young patients.

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Other downloads

Name Description Type File
Part 1: When to Go to the Emergency Department and What to Expect Common Reasons to Go to the Emergency Department pdf Download file: Part 1: When to Go to the Emergency Department and What to Expect
Part 2: What to Expect When Your Call 9-1-1 What to Expect When You Call 9-1-1 pdf Download file: Part 2: What to Expect When Your Call 9-1-1
Part 3: Educate Your Local Emergency Department About Being on the Spectrum Advocating for Yourself or Your Family Member With Autism pdf Download file: Part 3: Educate Your Local Emergency Department About Being on the Spectrum
Part 4: Common Reasons Someone With Autism Seeks Emergency Care Be Aware of Common Outpatient Therapies For Patients with ASD pdf Download file: Part 4: Common Reasons Someone With Autism Seeks Emergency Care
Part 5: Understanding Autism Spectrum Disorder (ASD): A guide for Emergency Medical Personnel Document for Emergency Medical Services (EMS) and Emergency Department (ED) Staff. pdf Download file: Part 5: Understanding Autism Spectrum Disorder (ASD): A guide for Emergency Medical Personnel

This information was developed by the Autism Services, Education, Resources, and Training Collaborative (ASERT). For more information, please contact ASERT at 877-231-4244 or info@PAautism.org. ASERT is funded by the Bureau of Supports for Autism and Special Populations, PA Department of Human Services.